MEDICARE: DR. JUSTIN ROBERT FAGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X008283-2	NY

General Provider Information

NPI Number	:	1861585432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN ROBERT FAGAN

Provider Business Mailing Address
First Line	:	1950 BALDWIN RD
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-4008
Country	:	US
Telephone Number	:	914-245-4494
Fax Number	:	914-962-2699

Provider Business Practice Location Address
First Line	:	28 MAPLE AVE
Second Line	:
City	:	ARMONK
State	:	NY
Zip	:	10504-1824
Country	:	US
Telephone Number	:	914-273-3485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	11/01/2016

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Directions to “ DR. JUSTIN ROBERT FAGAN ” Practice Location

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